Fill and Sign the Virginia Five Day Notice Form

5-DAY NOTICE TO PAY RENT OR LEASE TERMINATES - RESIDENTIAL TO: Tenant(s): FROM: Landlord Address of Leased Premises: NOTICE IS HEREBY GIVEN that you are in breach of the Lease Agreement on the above described lease premises due to failure to timely pay rent. Except as provided below, within five (5) days after service of this notice upon you, you must pay in full to Landlord the rent and other charges now due and unpaid, as follows: $ Rent for $ Late Charges $ Other $ Other $ Total (exclusive of future accruing costs Payment will be accepted only by: cash; money order; cashier’s or certified check; personal check IF YOU FAIL TO TENDER FULL PAYMENT, your Lease will be terminated and you must surrender possession of the premises to Landlord. If you fail, within the five (5) day notice period, either to pay the total charges in full, or to surrender possession of the premises, legal proceedings will be commenced against you to recover possession and to recover a judgment for the rent and damages for your unlawful detention of the premises, and all costs of court including attorneys’ fees to the extend allowed by applicable law and/or the lease agreement. Surrender of the premises does not relieve you of liability for the outstanding balance. The five (5) day notice period described herein shall expire at: o’clock [a.m./ p.m.], on the day of , 20 . LANDLORD RESERVES ALL RIGHTS AND REMEDIES UNDER THE LEASE AGREEMENT AND UNDER APPLICABLE LAW, INCLUDING BUT NOT LIMITED TO CONTRACTUAL DAMAGES FOR UNPAID RENT, AND NOTHING IN THIS NOTICE SHOULD BE CONSTRUED AS A WAIVER OR RELINQUISHMENT OF SAME. If you have any questions, please call , at . Signed, this the day of , 20 . Signed : Notice to Pay Rent – page 1 Landlord/Lessor, or authorized agent PROOF OF DELIVERY A copy of this Notice was delivered to Tenant: by hand by registered/certified mail at the above address, which is: the place designated by Tenant for receipt of communications; Tenant’s last known place of residence; by posting prominently on the front door of the leased premises. Notice delivered/mailed/posted by: Sign Name Print Name In his/her capacity as: Landlord/Lessor; Manager; Agent. Notice delivered/mailed/posted on: [date] Notice to Pay Rent – page 2